I hear this phrase, “You’re pain is all in your head” spoken to patients frequently and it’s one phrase that is forbidden in our office. While it is true that pain can have a central or “top down” component, it is far from fabricated. When I see chronic pain patients, I listen to their story to determine what may be contributing to their pain and preventing them from healing. I particularly look at the pain from three angles: (1) anatomic/biomechanical, (2) internal/external environmental factors, sometimes referred to as chronic inflammation, and (3) central sensitization (biochemical hypersensitivity in the brain and spinal cord). In this article, I will discuss the anatomic/biomechanical factors and will follow up in the next two issues with the last two factors.
When dealing with musculoskeletal pain, doctors may order an MRI, which often does not reveal the anatomic or biomechanical problem. An ultrasound, however, is an ideal tool for looking at areas of chronic pain. It can pinpoint the structure that is causing your pain and, because ultrasound can look at your tissues in motion, it can diagnose issues that non-dynamic tests cannot. In addition, because of its high spatial resolution, ultrasound can identify chronic changes in the soft tissues including the fascia that are not seen with MRI.
Here are a few scenarios where diagnostic ultrasound may be helpful in pinpointing the underlying pain generator:
1. When you lie flat on your stomach, can you bend your knees to 90 degrees without pain in your upper thigh and buttocks? If not, you likely have an old hamstring injury.
3. Do you have perpetual knots in your muscles? There are layers of multiple muscles and other supporting soft tissues like fascia, especially in the hips, shoulder and back. An ultrasound can easily distinguish among these layers to identify scarring.
4. Do you have persistent pain after joint replacement? Soft tissue scar in the muscles and fascia can be the cause of pain that mimics joint pain. Ultrasound is the test of choice for evaluating these soft tissues.
At Advanced MMC, we use ultrasound to look at soft tissues in the area of pain as well as the ones in that structure’s biomechanical or kinetic chain to make sure the entire group of tissues is working correctly and not putting strain on one structure or another. We also use ultrasound to evaluate the internal details of tendons, muscles, ligaments, nerves and fascia. If there is physical pain caused by any of these structures, an ultrasound should be able to reveal it and help determine how best to treat it. To learn more, call us to schedule an appointment.
